Abstract
Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American <i>Society of Anesthesiologists</i> (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.
Highlights
Nasotracheal intubation (NTI) is one of the most common methods used to incite anaesthesia for emergency surgeries in the head and neck region, when orotracheal intubation is not feasible
All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study
The study considered all the aspects of human care compiled with the ethical guidelines and technical requirements were approved by the Institutional Human Ethics Committee (IHEC) and Institutional Review Board (IRB), National Medical College and Teaching Hospital
Summary
Nasotracheal intubation (NTI) is one of the most common methods used to incite anaesthesia for emergency surgeries in the head and neck region, when orotracheal intubation is not feasible. Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma [1]. The most frequent complication is epistaxis, which may be occasionally troublesome, even with vasoconstrictors, with a smaller, softened and well-lubricated tube with careful manipulations. There have been reports of partial and even total avulsions of middle and inferior turbinate’s [2, 3, 4, 5]. An amputated turbinate may obstruct the nasotracheal tube, further endangered the patient safety [6]
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